The need for self-management in patients with Persistent Depressive Disorder (PDD) and their caregivers: A qualitative study using Grounded Theory

Introduction The Persistent Depression and Self-Management Study is a mixed-methods pragmatic randomized controlled trial that evaluated the “Patient and Partner Education Program for All Chronic Illnesses” (PPEP4All) in patients with persistent depressive disorder (PDD) compared to care as usual (CAU). PPEP4All is a brief, structured self-management program that focuses on functional recovery and involves the partner/caregiver in the program. The latter may improve patient outcomes and reduce caregiver psychosocial burden related to PDD. Objectives In addition to evaluating the cost- and clinical-effectiveness of PPEP4All, we conducted a nested qualitative study to deepen our understanding of how patients with PDD and their caregivers cope with chronic depression. Additionally we identify areas in which they require care and learn how they could benefit from a self-management program like PPEP4All. Methods In the nested qualitative study, 28 patients (16 from PPEP4All, 12 from CAU) and 9 partners/caregivers agreed to participate. The in-depth semi-structured interviews took place at participant’s home, the main research location, or over telephone. For each interview, we used a topic list, which was initially evaluated in a pilot study of patients with PDD. All interviews were audio recorded, with consent from the participant, and transcribed verbatim. Data were analyzed using Grounded Theory, with a constant comparative analysis method, using Atlas.ti version 9 software. Results Qualitative data are currently being analyzed. We expect to identify important themes relevant to the patient’s and caregiver’s personal experience and learn how they use and implement self-management in their lives. Conclusions PPEP4All may help patients with PDD and caregivers learn important self-management techniques to effectively cope with chronic depression and its consequences, and thus, it may help them meet their needs for care. Disclosure of Interest None Declared

Introduction: Around 1% of the general population have schizophrenia.It dramatically affects not only the patients who suffer from it, but also their family members.It represents a difficult task for family caregivers, especially at the time of deinstitutionalization of the patients, when they have to assume some of the functions and care previously provided by psychiatric institutions.This day-today care can influence the lives of the caregivers and cause anxiety or depression, which might affect the care that the patients receive.Objectives: The objectives of our study were to assess anxiety and depression in family caregivers of patients with schizophrenia and to identify associated risk factors.Methods: We conducted a cross-sectional study including family caregivers of patients with schizophrenia.Anxiety and depression were assessed using the 14-item Anxiety and Depression Scale in its validated version in Tunisian dialect (HAD scale).Statistical analysis was performed by SPSS 26.0.Results: We included 30 family caregivers of patients with schizophrenia.The prevalence of depression in family caregivers was 40 % while 56% of them were anxious.Six caregivers had both depression and anxiety, 63.3% of them were unemployed and 52.2% stopped working to take care of their relative.In our study, the schizophrenic patient's history of aggression towards the caregiver was statistically associated with depression (p=0.025 ).The worse the compliance of the patient to the treatment, the more likely the caregiver is to develop anxiety (p= 0.027).The parents (mother or father) were the most exposed to depression, anxiety or both (p=0.016).Family caregivers who lived with the patient under the same roof developed more anxious symptoms than the ones who didn't (p=0.005).The time spent taking care of the patient was higher for the caregivers with depression, anxiety or both (p = 0.046).Conclusions: Schizophrenia may cause a significant psychological distress for family members such as depression or anxiety .Several factors seem to be involved, inherent to the disease, to the patient and to the caregiver.

EPV0418
The need for self-management in patients with Persistent Depressive Disorder (PDD) and their caregivers: A qualitative study using Grounded Theory E. Solis1 *, I. V. Carlier 1 , N. Kamminga2 and A. M. van Hemert 1

Introduction:
The Persistent Depression and Self-Management Study is a mixed-methods pragmatic randomized controlled trial that evaluated the "Patient and Partner Education Program for All Chronic Illnesses" (PPEP4All) in patients with persistent depressive disorder (PDD) compared to care as usual (CAU).PPEP4All is a brief, structured self-management program that focuses on functional recovery and involves the partner/caregiver in the program.The latter may improve patient outcomes and reduce caregiver psychosocial burden related to PDD.Objectives: In addition to evaluating the cost-and clinicaleffectiveness of PPEP4All, we conducted a nested qualitative study to deepen our understanding of how patients with PDD and their caregivers cope with chronic depression.Additionally we identify areas in which they require care and learn how they could benefit from a self-management program like PPEP4All.Methods: In the nested qualitative study, 28 patients (16 from PPEP4All, 12 from CAU) and 9 partners/caregivers agreed to participate.The in-depth semi-structured interviews took place at participant's home, the main research location, or over telephone.For each interview, we used a topic list, which was initially evaluated in a pilot study of patients with PDD.All interviews were audio recorded, with consent from the participant, and transcribed verbatim.Data were analyzed using Grounded Theory, with a constant comparative analysis method, using Atlas.tiversion 9 software.Results: Qualitative data are currently being analyzed.We expect to identify important themes relevant to the patient's and caregiver's personal experience and learn how they use and implement selfmanagement in their lives.
Conclusions: PPEP4All may help patients with PDD and caregivers learn important self-management techniques to effectively cope with chronic depression and its consequences, and thus, it may help them meet their needs for care.

EPV0420
The antidepressant properties of ketamine (literature review) Introduction: Major depression is a common condition.Despite significant advances in psychopharmacology since the 1950s, the onset of action and drug resistance remain therapeutic challenges for traditional antidepressant agents, such as serotonin reuptake blockers.The recent discovery of the rapid antidepressant effect of ketamine, receptor antagonist, has revolutionized research in this field.
Objectives: demonstration of the antidepressant properties of ketamine Interest: None Declared EPV0419 Diagnostic and psychopharmacotherapy in the general practictioner practice F. H. Kraxner Center of psychiatry and psychotherapy, Hospital of Affoltern am Albis, Affoltern am Albis, Switzerland doi: 10.1192/j.eurpsy.2023.1758Introduction: Due to the often long-standing and extensive doctor-patient relationship, family doctors have special access to the mental state of their patients.They are often the first point of contact, and consequently the treatment of depression often begins in the GP's practice or even takes place entirely there.This requires dedicated knowledge on the part of the general practitioner, especially with regard to diagnostic criteria and treatment.Objectives: The aim of this article is to describe the basic diagnostic process for the general practitioner's practice, to give advice on the indication and implementation of psychopharmacological interventions, and to present the results.This overview summarises the most relevant connections to the diagnosis, assessment of the severity and psychopharmacotherapy of depression in general practice.Methods: The following therapy algorithms and remarks are essentially based on the treatment recommendations of the Swiss Society for Psychiatry and Psychotherapy (SGPP) and the Swiss Society for Anxiety and Depression (SGAD) as well as the German S3 guideline of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN).Results: Family doctors play a central role in the treatment of depressive disorders.They are often the first point of contact for patients with depression and in about 40 percent of cases even the only contact point.The likelihood of developing a depressive episode in the course of a lifetime is 10 to 15 percent globally.Evaluations by the World Health Organisation WHO show that 9 to 23 percent of people with chronic illnesses have depression as a concomitant illness.A cross-sectional epidemiological study in Germany showed that 60 percent of patients in general medical care were not treated with antidepressants and/or psychotherapy in accordance with guidelines.In Switzerland, about half of the antidepressants are currently prescribed by general practitioners.Image 1 shows a detailled overview (in German) of the current medication.Image: Conclusions: Specialists in general internal medicine have a central role in recognition and treatment of depressive syndromes.Somatic causes can be ruled out by means of physical examination, laboratory and ECG/EEG/imaging.Mild and moderate depressive episodes can be treated by psychoeducation, counselling and medication.If the symptoms are mild, psychosocial support or psychotherapy alone can be considered.If acute suicidal tendencies or psychotic symptoms are identified, emergency symptoms, emergency admission to a psychiatric hospital should be considered.The presence of other psychiatric comorbidities, resistance to therapy or complex psychiatric medication necessitate referral to outpatient specialists.Metabolic and cardiovascular side effects and interactions between psychopharmacological and internal medicine must be considered.Disclosure of Interest: None Declared